CIHM 
Microfiche 
Series 
(Monographs) 


ICMH 

Collection  de 
microfiches 
(monographies) 


Canadian  Institute  for  Historical  Microropror^uctions  /  instltut  canadien  de  micrortjprodjctions  i.istoriques 


Technical  and  Bibnjgraphic  Notes  /  Notes  techniques  et  bibliographiques 


The  Institute  has  attempto  j  .c  obta;n  ;h9  best  original 
copy  available  for  filming,  i-';-  i>i-Gs  of  the  copy  which 
may  .  ">  bibliographicallv  ■  'i'^u  c  v  hioh  may  alter  any  of 
the  linages  in  the  ;  :orDduc*ion,  or  wnich  may 
significantly  change  the  :. o.u!  m^mod  of  filming  are 
checked  below. 


D 
D 
□ 

n 
□ 


Coloured  covers  / 
Couverture  de  couleur 

Covers  damaged  / 
Couverture  endommagee 

Covers  restored  and/or  laminated  / 
Couverture  restauree  et/ou  pelliculee 

Cover  title  missing  /  Le  titre  de  couverture  manque 

Coloured  maps  /  Cartes  geographiques  en  couleur 

Coloured  ink  (i.e.  other  than  blue  or  black)  / 
Encre  de  couleur  (i.e.  autre  que  bleue  ou  noire) 

Coloured  plates  and/or  illustrations  ,/ 
Planches  et'ou  illustrations  en  couleur 


nBo  jnd  with  other  material  / 
Relie  avec  d'autres  documents 


D 


C 


D 


D 


Only  edition  available  / 
Seule  edition  disponible 


n    Tight  binding  may  cause  shadows  or  distortion  along 
-I    interior  margin  /  La  reliure  serree  peut  causer  de 

I'ombre  ou  de  la  distorsion  le  long  de  la  marge 

interieure. 


Blank  leaves  added  during  restorations  may  appear 
within  the  text.  Whenever  possible,  these  have  been 
omitted  from  filminy  /  II  se  peut  que  certames  pages 
blancnes  ajoutees  lors  d'une  restauration 
apparaissent  dans  le  texte,  mais,  lorsque  cela  etait 
possible,  ces  pages  n'ont  pas  ete  filmees. 

Additional  comments  / 
Commentaires  supplcmentaires: 


L'Institut  a  microfilme  le  meilleur  exempiaire  qu'il  lui  a 
ete  possible  de  se  procurer.  Les  derails  de  cet  exem- 
piaire qui  sont  peut-etre  uniques  du  point  de  vue  bibli- 
ographique,  qui  peuvent  modifier  une  image  reproduite, 
ou  qui  peuvent  exiger  une  modification  dans  la  metho- 
de  normale  de  filmage  sont  indiques  ci-dessous. 

Coloured  pages  /  Pages  de  couleur 


Pages  damaged  /  Pages  endommagees 

Pages  restored  and/or  laminated  / 
Pages  restaurees  et/ou  pelliculees 


D 


I      ]    Pages  discoloured,  stained  or  foxed  / 
'    Pages  decolorees,  tachetees  ou  piquees 


I      j    Pages  detached  /  Pages  detachees 
Showthrough  /  Transparence 

n 


n 


Quality  of  print  varies  / 
Qualite  inegale  de  I'impression 

Includes  supplementary  materia!  / 
Comprend  du  materiel  supplementaire 

Pages  wholly  or  partially  obscured  by  errata  slips, 
tissues,  etc.,  have  been  refilmed  to  ensure  the  best 
possible  image  /  Les  pages  totalement  ou 
partiellement  obscurcies  par  un  feuillet  d'errata,  une 
pelure,  etc.,  ont  ete  filmees  a  nouveau  de  fagon  a 
obtenir  la  meilleure  image  possible. 

Opposing  pages  with  varying  colouration  or 
discolourations  are  filmed  twice  to  ensure  the  best 
possible  image  /  Les  pages  s'opposant  ayant  des 
colorations  variables  ou  des  decolorations  sont 
filmees  deux  fois  afin  d'cbtenir  la  meilleure  image 
possible. 


This  Item  is  filmpd  at  the  reduction  r.itio  checked  below  / 

Ce  document  est  tilme  au  taux  de  reduction  indique  ci-dessout. 


lOx 


14x 


lex 


12x 


16x 


20x 


22x 


26x 


30x 


24x 


28x 


32x 


The  copv  filmed  here  has  been  reproduced  thanks 
\o  the  generosity  of: 

J.J.    Talman  Regional    Conection, 
D.B.    Weldon   Library, 
University  of   Western  Ontario 

The  images  appearing  here  are  the  best  quality 
possible  considering  the  condition  and  legibility 
of  the  original  copy  and  in  keeping  with  the 
filming  contract  specifications. 


L'exemplaire  film6  fut  rtproduit  grace  A  la 
g^n^rositd  de: 

J.J.    Talman  Regional    Collection, 
D.B.   Weldon  Library, 
University  of  Western  Ontario 

Les  images  suivantes  ont  i\i  reproduites  avec  le 
plus  grand  soin,  compte  tenu  de  la  condition  et 
de  la  nertet*  de  l'exemplaire  iilm6,  et  en 
conformity  avec  les  conditions  du  contrat  de 
filmage. 


Onginal  copies  in  printed  paper  covers  are  filmed 
beginning  with  the  front  cover  and  ending  on 
the  last  page  with  a  printed  or  illustrated  impres- 
sion, or  the  back  cover  when  appropriate.  All 
other  original  copies  are  filmed  beginning  on  the 
first  page  with  a  printed  or  illustrated  impres- 
sion, and  ending  on  the  last  page  with  a  printed 
or  illustrated  impression. 


Les  exemplairer  originaux  dont  la  couverture  en 
papier  est  impnmAe  sont  filmis  en  commencant 
par  le  premier  plat  et  en  terminant  soit  par  la 
derniire  page  qui  compcr      ur.a  empreinte 
d'impression  ou  d'illustrb.  on,  soit  par  le  second 
plat,  selon  le  cas.  Tous  les  autres  oxemplaires 
originaux  sont  filmis  on  commencant  par  la 
premiere  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration  et  en  terminant  par 
la  derniAre  page  qui  comporte  une  telle 
empreinte. 


The  last  recorded  frame  on  each  microfiche 
shall  contain  the  symbol       ^    (meaning    "CON- 
TINUED"), or  the  symbol  V  (meaning  "END"). 
whichever  appiies. 


Un  des  symboles  suivants  apparaitra  sur  la 
derniire  image  de  chaque  microfiche,  selon  le 
cas:  le  symbole  — •-  signifie  "A  SUIVRE".  le 
symbole  V  signifie    "FIN". 


Maps,  plates,  charts,  etc..  may  be  filmed  at 
different  reduction  ratios.  Those  too  large  to  be 
entirely  included  in  one  exposure  flre  filmed 
beginning  in  the  upper  left  hand  corner,  left  to 
right  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diagrams  illustrate  the 
method: 


Les  cartes,  planches,  tableaux,  etc..  peuvent  etre 
filmis  A  des  taux  da  reduction  diff^rents. 
Lorsque  le  document  est  trop  grand  pour  etre 
reproduit  en  un  seul  cliche,  il  est  film6  ^  partir 
de  Tangle  supirieur  gauche,  de  gauche  d  droite. 
et  de  haul  en  bas.  en  prenant  le  nombre 
d'images  nicessaire.  Les  diagrammes  suivants 
illustrent  la  m^thode. 


1 

2 

3 

4 

5 

6 

MICROCOPY    RESOlUTION    TEST    CHART 

ANSI  ond  ISO  TEST  CHART  No    2 


1.0 


I.I 


Ui  |M      III  Z5 

i^   1^     IJIJJ^ 

'-    '     Ip.o 

mil  1.8 


.25 


'•4   mil  1.6 


^      -IPPLIED  IM/1GE     Inc 


T    ^ 


J 


A  Study  of  the  Buffer  Value  of 
the  Blood 


u     i,     I-  !■  \  ^ ,  M  i» 

I!  \I.TI  Mii|;r: 
AM' 

!.    1 ,     k(  )\\  \  r  u  I',  i:.  Mi), 


Rff-iiiitt-d    lidiii    ilh'    .  Ill /ii:r.«    tif   liitciiHil    Mi'iliiiiu- 


I    III!    .\>." 

l-Vr     II'v'-VM     »\n      ("II'IV    livr     N'nllTM      Dfahp'.kn     Strift 

1-1, 


A  siru\   (ji 


111'   J;ri'i-'i:k   wm.l'i-:  cu-   thi-;  iii.ood* 


K.     L.     Li;\V.     Mb.     .AND    I..     G.     KOWXTREK.     M.D. 
ii\'Ti^i"J"!  Ml^■.\-^\^•c.l.I^ 

In  iinlcr  llial  tin-  \ariini-  luiutidii-  ni  tin-  1„m1v  iiiav  In,-  prnpfrK 
pi.rfnrnic<!.  it  i^  i-~i'i;lial  that  tin-  l,i(,(„l  maiiitaiu  it-  >li-lul\  alkaliiK 
i-<arti.,ii  within  fxlixiiiclv  iiarri.u  limit-  When  liii.  dc^'rce  ot  ali<a- 
Hnity  i-  (limini-hid,  a  run.iitmn  cn'  aci(i..-i~.  with  it-  aiaompaiiyiiig  phf- 

numiMia,  w  (ih-cr\(.l        \   irnU    ari.l   ti-artinii  ,,|-  the  M 1   i  tliat  i~,  a 

h\ih-u,r,.|i  i,„,    oincciitralidH    ^ivatir    than    pll-7.iiTi     i~    in,  (unpatiliK 
will)  h'l'c. 

XaniMi-  luajicelnr  tii,rh,aniMiiv  -rrx  e  U,  maintain  the  acid-base 
(•>|nihhriiini  ni  the  (.r-ani-m  and  tia-ixhy  i,n,t^vt  the  Mood  from  Mgiiiti- 
caiit  chani;r~  m  h\  tlruL;en-ii  .n  i-niurniration.  Surh  processes  are 
mcrca>cd  jirochiction  of  ammonia,  tlic  e.vcrction  ol'  carbon  dioxid  b\  the 
lun.i,'-.  the  excretion  oi"  nonvolatile  acids  by  the  kidnevs.  and  linally,  the 
hulVer  action  of  ih,    hi 1  ii-rlf.' 

l;y  the  term  "biHIer  acti,.n"  of  ;i  mixture  i-  meant  its  ability  to  take 
ni.  coiiMdcrable  anionnl-  ni  acid  or  alkali  when  iIicm-  arc  adi'led  to  it. 
without  api)recia!ile  ,han,<,'e  in  hydroRcn-ioii  concentration.  'Ihe  bki.id 
i-  such  a  btiirer  mixture,  ou  m-  iar<;ely  to  it<  content  nf  carbonate>  an.'. 
pho>phate-.  and.  to  a  le~~er  ixteiil.  it-  protein. 

Much  \,  Iiiahle  work  ha-  been  done  to  determine  ti.e  r^le  played  ;iy 
each  of  the  f.utor-  CMnceriied  in  the  maintenance  of  acid-base  equil  b- 
rinm.  hut  a  jireci-e  iiive-tigati.m-  of  the  -butler  \alne"  oi  t!ie  blood  has 
not  been  undertaken,  owins.;  to  technical  clifticultie-.  The  utdization  of 
tile  recently-described  dialy-i-indicator  method  f(ir  determinMii;  varia- 
tion- in  tlu'  b\dro,-en-i,,n  c..iicentrati..n  ,,f  the  bl 1  ha-  made  possible 

a  (Hiantitati\e  -tndy  of  it-  hiilVer  \alue. 

I'rom   llie   .\K.lic..l   (  Iniie  .1    ilu    .lohns    lk.pkin>    Hosijitul 
■PH    I-   -he   ...n^n,.nl^    .,.,v|m.,I    ..m,,!,,!     „  „-    l,.v,|r,,u,„-,.,n    CDeentrafon, 
1.   l-..r  a  deiai  nl  ,li..„-si-..  .^f  ihe  mechanism-  involved   u.  the  ma-ntenciice 
..     ac,.l-l,a-e_e,|,i.l,l.,,u,,,   ,„   ,1„    |„„|,.   .,,,    1 1,,,,!., -,.„.    I.,  j..    |.;,„|,„.  .|.    ].|nv  ,| 
1  'I I'',  vni.  3.1-4. 

-'  I'nrn,;;  il„-  ouir-c  ,.,  n,i-  mu.Iv.  a  prrlnnin.ir,  ,  ..mmunu-alinn  ,„,  •'The 
-Nalure  ,,„.l  I  eteel,.,,,  .,|  l),.,!„tu  \,„l,,.,..-  |„  \  .,„  vKke,  .S„||,„an  ,„M  .  ullcr. 
apiH-are,!  ,„  the   IV.c  N        ,,„„,,  ,;„.,    ,„„,   ^,,„,      ,„,-    ^.,    ,,,.       .,1^^     .^.^  ^^^^^• 

tl  .   .  ial.s-,-.„.,l,cal..r  nutli,,,!  «a-  Ih„,«  utili.-e,!   i,,r  .lctenn,ni„K  the  hutter  valm- 
•■1    111.;   I.l,.,„l    was   aMn..,Mie.-.l    «ith    tlu-    pr, -,  nt.u.en    ,,t    our   method   h-lor,'    the 
A-neiation   ot    .\meruan    IMi.v  sican-,    M.,v     I'M,-      i  .sec    Tr.    .\-„     A,,,     P|,v. 
l''l.i.  and  ah'itract  m  .hmr.  .\m.  M,,|    .\smi..  I'M,,.  I^iv   JU,J  i  '    " 

J  I.ev.v.  R.  I..  Rowntrcc.  I.  (;.  and  Mam  ,tt,  W.  MckTu,  :  .\  Simple  Method 
for   IMermtmni:   \  ariat.o,,-   ,„   ,|„.    Hvdn..e„-h,n   t  ..iKeiitrali..,,   ul   the   Wood, 


• 


The  ,Ktcrn.i<mt:u„s  max  l.c-  oarri.,1  om  on  whuk-  1.1.. ..1,  ,vr.>m  or  plaMua.  but 
it  i,  prelcraMc  lo  u^i'  whole  bloo.l.  ^hu■c  in  iliis  way  con.htu.n-  m  the  ho.ly  arc 
ir.ci^t  clo>clv  aii|iroxiniatcfl.  .  , 

Two  cnbic  ..-ntintctfrs  <,t  Moo.l  ar.  flacd  .n  .ach  ot   >cvu,  tct  t.h  >  .  u 
;,llow..l  to  sta.nl  tor  liv.-  or  six  .ninut.>,  until  a  tlnn  layer  ot  plaMna  at    1r  to 

as  bf.n  cUar..l  of  c.ll<.  lutt.olvMs  on  the  M,hs..,ucnt  a.l.luion  ot  aoni  atul  alkal. 
tCr 'l,  I,  ■  c  ,,r..v.n,.,l.  The  Moo.l  in  the  hr^t  tube  is  n.e.l  lor  a  .letennnjatum 
o    tl      ,.         T o  eac-h  of  the  nest  three  tubes  „  a-l.le.l  f,f,.eth-nor,nal  hy.lrochlortc 

a  il-dl   c.e  to  the  lirst.  d.i  c.e.  to  the  seeond.  an.l  .1.3  c.cto  the  .Inr.l.     Sun,- 

iarlv.  increaMUK  a.uonnts  of  t,ftieth-nor,naI  so.liutn  hy.lroM.l  solutu.n  a^-;  •?'l;  -' 

.,,  the  la-t  three  ttibes.      rhe  tubes  are  inverted  once  lor  the  imrpose  ot  niiMnL.. 

l-ach  nortion  of  blond  i,  then  s.parately  dialy/.ed  for  six  minutes  aKaui^t  -.;  ex. 

,;     y  .  ^eent.  sal.  .dntion  and  the  „H  of  the  dialy^a.e  determu.ed  by  addm. 

5  ,lro,,'   of  an  indieafr.  ,,lunolM,l,,hone,.!uhalen,.  the  read>n«  be.nu  deteinuml 

■.y   comparing  with  a  -erie,  of  -lanilard  colors. 

XitnRToU^  exiierntR-nl^  were  .■.•,rru-,l  nut  .-  .Icmni.u-  tin-  nitluaue 
Ml  \ari()u-  factors  ,m  the  rcsult>. 

1  /•//.•.•/  ,./  Tnnrn-.ninr.  The  .li;ily-;ile  at  teinper:itures  rimsm;.' 
Mvtn  IS  tn  .V-  C.  niav  1.-  nlr.uieal  or  may  -hnu  -lisl.t  chaii.nes/  hut 
n alhin  these-  cxlren.cs.  no  e-e.il.al  elianoe  j.  seen  in  the  hulter  vahie-  ot 
enli.-r  hknul  or  -erum.  Tlic  .leteriiliiialion-  eat.,  ihefelore.  he  earr.e.l 
,„U  at  ruo.n  tenivefature.  yvi^lmnl  feoanl  tor  the  -liirht  v.-.r.at.ons  .,, 
eiU'iiUiUerecl. 

_'.  /.,•».///(  of  liiiu-  hLipsi,,,,  i'n-twc.-ii  tiu-  Withdnn.al  o/  lUood  ,:ii.l 
,/,.■  Cn-yy'iiui  Out  of  I >rt,-ywi„ations.-^[h^  hlo...l  may  l,e  kei-t  tor  a^ 
Ion-  as  twenlv  hmr  ii..nr>  xvith.ait  ehans;e  in  the  \A\  or  hnlter  vnhies. 
pnTvicHn-  11  i^  eulUvUd  in  hanl  t^la-  Uihe--  wliieli  are  hlUnl  to  the  n.]., 
li'ditlv  -toitcreih  an.l  inmie.hately  \:lwv<\  on  ice. 
~  3.'  Lcn.ith  ..,  limr  Ihr  Acid  or  Alk.iU  is  iu  Coulact  :cilh  Blood  or 
V.-nnii.^A  ~evie>  ..i  exi.ernnent^  ua-  earrie.l  ..nt  in  uhi.h  the  time 
„,  ,-,„,t.ui  varicl  iniin  two  to  lliirty  minute-.  Within  tlie-e  hmit-. 
i.l.iuieal  huller  \ahie-  were  ohlained  in  all  cases. 

4.  Loss  oj  (\irh.u,  /»,-,u7./.-ni,Ni,,n-lN.  the  carhon  .h..M.l  teuM.H.  m 
the  hlood  U  nni.,,rtant.  (onlml  expennuni-.  n-iii-  the  .lialvM- 
in.hcator  iiu  ih.  ,1  uilh  earlu.n  .hoxnl  at  f,-  n..nnal  ten-.....,  an.l  uith 
Mno.l  lv..m  unieh  ...rh.H.  .h-.M.l  ha.l  heen  shaken  .ml,  ~h•'^^''^\  ma'ke,. 
,,i,-,Vrenee-in,-ll  It  „  , ..  ,.Mhle  t. ,  ,  ,  .lleet  the  h!.  „  „1  in  Mteh  a  way  that 
,lu-  1,,.-.,1  ...rii.iii  .It.iM'l  i-tninmialaii.l  lan'l)  cii-laiit       Ihisi-ace.mi 

,,l„lu,l  l.v    with.lrawinu'  hi '     -"1'  :>  -.^niii;e  ,,r  i.ii.et.  hUin.t;  the  te.t 

mhe  practicalh  t.,  th,-  t..p,  ia..n,,.tlv  ^Xnyyvuu^.  av...chi.u  minece--arv 
-hakin-  an.l  i.la.anL;  nnnte.hateU  ..ii  ua  ,  Ih.iih.ate  .lelenmnatt.  .n-  .  m 
,1k-  -ante  -.itni.le.  ..r  ..n  .htter.nt  -i.eemien-  ff..ni  the  -amr  ni.liM.ln.il, 
yiekl  e-.eiiliall\    i.lenti.'.il  rc-ult.-  ini'ler  tlic-e  .■.in.hlnni- 

4rilvv.  K..wmree  an.l  Marri.Mt.  b  c.  cit..  i.ote  X    The  t.m,   ■  .i  ,  xp..M.re  to  a 
hiKlie-r  temiieratnre  is  ohvionsly  a  determininn  facL.r. 


Ml  'HI    I  ii    i..\ri,'i;»iii\  111-   i<i:.-.r  i.i> 

All  rrsiill>  ;iii'  I  x|irt<-icl  in  tirms  nl  cubic  cciitimiiirs  of  liltiitli-iionii;il 
Inilroclilnric  ncid  nr  Micliiiin  liydroxiil  per  2  c.o.  n(  lilodd.  Tlio  follinviiin  lirins 
.'ii   iwiil : 

1.  lUiihr  for  .Itid  .'i-  . //',■, ;/i.--'riii-c  ri|iri-ciit  tin-  uininiiil^  ul  ;ici(l  .ir  a'kali 
ttliicli  can  In-  adiKd  to  lilo.  nl  or  siruni  witliuiit  rliaiiKc  in  the  pi  I  o|'  tlic  dialyviti-.' 
Till-  sum  of  the  butfcr  fur  acid  and  that  for  alkali  yields  the  Icltil  I'liftrr. 

2.  h'lsrrvi-  Buffer  fnr  .Uid  nr  .llknli. — These  represent  the  amounts  of  aciu 
i-r  alkali  which  can  be  added  to  blood  or  strum  without  causing  a  change  in  the 
|)H  of  the  dialysate  beyond  the  limits  of  normal.  The  sum  of  the  two  yields 
tlie  lt>tal  rcsvrrc  buffer.  Tlie  reserve  buffer,  therefore,  represents  the  simple 
bulTer  value  /•Ins  the  atiiount  of  aeid  or  alkali  taken  care  of  by  the  blood  without 
ebanije  in  riactiun  beyond  the  limits  of  normal  pH  values.  I'rom  a  clinical 
standpoint  it  is  the  simple  bnlTer  valm  s  for  acid  and  alkali  which  an  ..f  tlie 
t;r<  alist  sii;iiiticance. 


\.\\I.^SF-.S     OK     Cl.l.Ml.M.     KIlSfl.TS 

I  lit-  wurk  is  liastil  on  a  sttldy  ni  sj\ty-li\e  cases,  iiivulviiii;  coiisirl- 
cralily  niiire  than  100  hiit'tVr  ilcti-riniiiatidiis.  Tlie  n  siili,  ni;iv  !,i'st  lie 
|iri>sinliil  l.\   .li\i(lii)<;  tin-  eases  into  I'mii-  gnniiis, 

I.  .\i'nii,il  I  udiiiilnals  i  7i^\-iit\-l'oin-  Casrs  \.' — Determinations 
were  made  aw  Imlli  lilnnil-  .iMil  scrum,  the  resuli.s  a]iiieariii<;  in  Tables  1 
and  2.  It  is  imu wnrtliy  thai  llie  lime  ela]isiiij;  hetvvceli  the  previous 
me;d  and  the  withdrawal  ni  hliind  inr  rNamiiialinii  m.ide  im  essential 
ililTereliee  in  ihe  hnlTer  valtte-.. 

((M  lUodd.  .\nnnal  hlnuil  lakes  n]  ,-,r.  nf  ,ioid  or  alkali  wiiluiut 
ehanj;e  in  ].!  I.  Ii.  iherefore,  has  .i  Iml'ler  fi,r  a.  id  ,ind  alkali  of  at  least 
n.l.ihiitlyh  it  iiia\  ha\e  a  htttl'er  nl"  I  l.i  in  ( 1.4.  Ihe  a\  i-raffe  htllTer.  hotll 
tnr  aeid  and  .illv.ih  i-  d  IS  IIk  inl.il  linlVer  r.niyes  fiMin  Hi  i,,  (1.7.  \\itli 
a  l;iii11|i  .i\  erai^e  nl  i).M\. 

llu     re-erve   IjtitVer'    Inr   hnlh   .leid   ,uid    alkali    v.irii-    trniii   (i|    to 
114,  llu'  L:i"nii|i  .a\ei-,aye  t'nr  the  .■leid  lieiiiL:  d.i".  llial  fnr  llu-  .dl-ali  n  i| 
I'he    tnl.d    n-er\<-   ImlTrr    •  .irie-    I'rniii   Ii4    in   1)7.   ilu-   ^r,  ,M]i   .aver.ai^e 

hellli;  II..^S. 

( /' )  .S'lTiu)).'"—  .Xnniial  -enilli  .il\\a\-  Lakes  II  I  e.e.  nl  .aeid  willimit 
chaiifjc  in  pi  I.     It  ni,i\    h.ixe  a  luiticr  fnr  .i.id  <ii  frniii  0  1  in  11  .^  :  ihe 


5.   Xo  alidiipt  was  made  to  d'tennnie  cliaiiyes  ^iii.dler  llian  0.05. 

().     .Normal  pH  values  are  :     Blood.  7.4  to  7.6 ;  .sleriim.  7.(i  to  7.8. 

7.  The  blood  on  which  these  dctermiiiatioiis  were  made  was  obtained  from 
patients  in  the  Gonito-rrinary  Dispensary,  a  majority  nf  whom  were  under  treat- 
ment for  local  infections  of  the  lower  «c-iiitn-iiriiiar>  tr.ici.  Xo  bmir  iii.li\idaaN 
are  included  in  the  scries. 

S,  llu-  blood  was  collected  m  tubes  eoiii.iiiiiny  iii^i  -iilliciml  >  ai  in -iiau -free 
s-diiiiii  ci\,date  to  prevent  clottinj;. 

''.  Ihe  reserve  values  ilirnuKhout  are  not  absolute,  since  in  iii.iii\  instances 
IV.>  c.c  of  acid  and  alkali   failed  to  carry  the  pH  beyond  noriii.il  liniiN. 

10.  The  values  for  oxalated  jdasma  are  essentially  the  same  as  (host-  i',>r  serum. 
ThrouKhont  tlic  later  studies  oidy  whole  blood  was  utilised,  for  the  lollowiiif,' 
reasons:  1.  In  the  body  it  -s  with  the  buft'er  of  tlu  Iilond  .i.  ,,  whole  with  which 
we  are  eoiicerued.  2.  Less  blood  suffices.  .1.  t'entrifnuali/iiilnn.  together  with 
the  residtaiU   loss  of  carlion  dioxid.  is  avojilnl. 


:^    s? 


>       j3      i^      i;      jD      r      X       i:      «      «      '• 


1-         X         X 


-        ~;       "T       ''^ 


'  •     -  X     I-     "r     '■:     =•     ^     •-     '" 

I     +       «  ,;    1-    I-    i-    I-    '-    '-    •' 


1-    t-    I-    I- 


i-    I-    I- 


< 


^l'^ 


,-    I.    I-    I- 


K         I-         -,         "- 


i-         1-         I- 


ill-     ' 

all 


(_      I-      I- 


J      ^      -^      » 


).      t-      I-      I-      i'      «• 


1     +     ' 


«      u^      c      o 

I-    I,;    I-    I- 


t-    I-    t- 


I-    I-    i~ 


t'.         1.^         I-         M         r         M 


'-^         VI         V^         - 


t-      i-      I- 


a    I 


,^      I-      t-      I- 


nxcrayc  i-  Oil.     It.s  Imllrr  idr  alk.ili  i--  \(.r\   \arj.ilili- ,  a  chaMgt-  ma)  be 
ciKeur.itcrid  on  the  adilitinii  of  troiii  0.05  to  0.3  c.c.  of  fiftieth-v"  n  .] 
sodium  li\(lr(i.\iil :  tlu' aviTa;,'i' i^  0.07.    The  total  ImfTci  fur  .-i  niir. 
from  (1.1  tii  (i.i.  IJK'  sriiuji  a\(Tat;e  being  H  IX 

riif  rt.'-er\c  liutl'i.T  idr  aoid  varii"-  f  rum  II.  i  li  j  i '  4,  tin.-  ,:;rin;ii  avi-iagc 
luing  0,2.  riu'  rf~cr\r  butYvi  i'mi-  alkali  raiit;f>  I'rum  ((  tu  <)..i,  the 
group  .iverage  hciiig  0  IJ  1  ho  total  reserve  butter  \arii>  from  U  1  .^  to 
0.6.  the  average  being  U.33. 

T.\BLE    2. — SUMM.MIY    OF    TWE.STV-Fill  R    X(jKMAI.    C.\.sks 


BIooil 


Serum 


I 

Buffer ;  For  nlkiili....         11.2  •  0.4 

I  Total 

(  For  aciil... 
Rf.s.rve  l.iilTcr...     '   For  iilkall. 

i  Total 


Kstrcnips 

Group 
AvcriiK'' 

FMrnnrs 

0.2  •  0.4 

0.:8 

0.1    -  0.3 

u.;  •  0.4 

0.18 

0       -  0.3 

1  .L'      0.7 

0.36 

0.1     -  0.3 

0:2  ■  0.4 

0,27 

0.1     ■  0.4 

0.;  •  0.4 

0.31 

0       -0.3 

0.4  ■  0.7 

0.58 

0.13  ■  O.fl 

(^roiip 


0.11 

0.07 
0.16 

0.12 
0.33 


1    WBl.lC    ,\ — MiSlII  L.A.MjUS    t"\>l>    WIlll     XhRM.M     pH    .XNP    XuKMAI.    Hi  h-lk 
\  ALUhs  ;     Sl.MhLN     LA>K.-5;     TuLMV     UhlhK.MINAllu.N'S 


Blood 


I'.iiiTcr.. 


f  For  acid 

{  For  nlkali 

I 

I  Total 

Fi.r  a.i.l 

H.s.rvf  biifTtr ;  For  alliali 

I 

1  Total 


Kxtrenifs 

0.1 

0.3 

0.1 

0.3 

0.2 

0.5 

0.1 

0.3 

0 

0.3 

0.3 

0.6 

Group  Average 

0.13 

0.17 

OS 

0.28 

0.23 

0.48 


-Mthongii  the  li.it'il  butler  \alue  or  the  total  reserve  value  mav  be 
g'^'at,  the  butter  f^r  either  aeid  or  .ilkali  nia\  be  -mall:  in  other  word?, 
the  butter  m:i\  be  gre.it  lor  aeid  and  small  for  .dkali,  or  \  iee  \er~a. 
Ihi-  e.in  be  determineil  only  by  aetuil  ^tudy  of  the  indi\iilual  aeid 
and  alkali  butler  \alue<.  .•ind  it  is  ob\  iou-ly  not  ^liowii  b\-  ,i  ligure 
expressing  the  total  Initter  value. 

2.  Misi(-lliiiu','iis  ( \:si-s  :e/7/(  \,inii,il  p!l  ,ind  .W'niuil  Ihttjcr  i  'iiliiis. 
- — I'weiity  determination-  were  made  on  sixteen  eases,  ineluding 
instaitees  of  diabetes  mellitus.  jiernicious  anemia,  mvcloid  leukemia. 
t\|ihoid  fiver,  pregnaney,  .-urgie.al  ea-e-  before  ;ind  after  atie-thesia, 
exo]ihthalm'.:  goiter  and  ehrotiie  ne])britis  i  i'able  .i). 


.-      r  s      .-  * 


r   '  ■  "i  .'   7. 


'-''■.         -.•■.  ■•_>'.■/-    -"^  > 


S    ^    5  _  — 


a    II 


■4    tf       S       «    ^    "i       ••    ^    '1    r    ■-.    •■. 
i3    ,:        tl        t^    t'     t-        I-     i-     '-     t-     '•    '- 


I-    I-     I- 


I.        I-     I-     I-        I-        «- 


i_  r-      I-      I- 


X      i 


t-     I-     I-     I- 


-    «    ^    ii    -^    ?! 


tl      V      u! 
I-      r-      !• 


t    ••    T,    I,;    t<    f: 


:3j;i 


H  u  =        =  a 

O  i  r      C  .6 


~   =.  s 


^'  £  " 

c"     c"     — 


fe    e 


4.4 


7       •.7 


zZ    <*    *•    t 

_  »  L    -     .  c  t    ;:  i 


^    ^     (-. 

e     e 
=     c 


>*    ^    ^ 


r  1  = 


lr,S 


^  i 


3  T  =^>  a: 


riu-  \,i',iK~  iililaiiml  aTl-  uniluniiK  -liL;liil\  luwtr  ilian  tim-i  uh^i  r\t-<l 
ill  ilic  ^rrir-  Ml'  iiuniKiI-.  liin  I'llnrwi-i  piT^iui  im  n  .itinc-  cit  c-in-oia! 
inti'i<-l. 

,1.  C  (i.v'i'.v  i^itli  Xiiniiiil  pll  (i:n!  I 'iiiiliiisliril  lUiiicr  I'ahics.  —  I  l:ilili.~ 
4  ,111(1  5.  I  All  :i!i,il\-i-  (if  i.lii-i-  taMi--  -lidu-  (.■-~i-iiti,ill\  iidriiKil  l>ul'ur 
.111(1  i\-S(i\i-  liiilTrr  \ahii-~  for  aiid.  niarlvcdlv  (liiiiini~!u(l  \aUu'»  loi" 
alkali.  aii(l  tin  v.  iLv,.  |M\\irc(l  v.aliu-^  lioth  l(ir  tot.al  and  iclal  ic-i-r\v 
ImlVcr-. 

ScMTal  |i(jiii!-  i>i  iiiU-ii-l  an-  (.■\idinl  irciii  .a  <  (iii~iilcr.ili(iii  of  tin? 
i;roup  (if  I'.iso  It  is  -triking  that  .a  dimiiii-li(-'(!  luilYir  for  alkali  i>  far 
iniii\  1(1111111(111  tli.iii  iliai  for  acid  in  (.'asc^  wliicli  dn  iKit  >li()\\  a  /)•«.' 
.icidd^i-.  lint  ill  \\liii,'li  tluTi  i^  ;i  IvikU-iu'v  tow.iril  aridn-i^.  .'i-  i\"i(lcii(.-i'(l 
ill  iii.iin    iii-t.iiui.-  li\   .1  liiwirini^  nf  llu-  ttn^idii  nf  tin-  ahidl.ir  carhoii 

r\i'.l    1      5       (    \>l.~    WJUl    XuKMAL    rli    AMI    |)|MIM>llMi    Hi   Mil!   \' \i  rK.!^ ; 

SixiKKN  Cases.-  Twi mv-I-ivi    Dkii.kmin'\tiii\> 


BInii. 


t  - 
5  = 


HulTcr 


Kl•^.■r\(■  hi.i'.r. 


I  F.ir  aii.l 
i 

.;  F(ir  :ilk:ih 
I 
1  Tiitiil 

I  For  mi. I 

I 

!  For  alkMl 

I  Tcliil. 


KxtriMiH'i* 

Grodi'  .XviT.iK 

'1.3 

O.l' 

11      ■  0.3 

0.1)11 

11     •  (I.e. 

O.X'i 

(1.211 

1...1 

U.l* 

tt.:l  -  (i.ii 

ll.Jl 

P  =  s 

% 

«  1.  r 


iliu.\id  (  (  .i~<.'s  1,  2,  4,  5.  10  and  Id  i  I  In  iliniinislu'd  luitUr  l(ir  alkali 
olisfrvid  III  two  i-asi's  of  nonn.d  pu  ljilhii  \  i  Ca^c^  14  and  15i  is  in 
accord.iiii  1  Willi  lli(  .iliiiii-l  iiin-t.iiit  tiiidiiiL;  nl  a  Idwiicd  alveolar 
carbon  didNid  hii-imi  ilntins,'  tlic  nimitli- (it  j,;(.'~iation.'' 

Case  4  (  iiHT.  iirii' cliKirid  ]iiii-iiiiiiii:  i  ^Ikiws  at  variolic  ~l.ii;t~  diiiiii!; 
Ilif  clinical  C(iiir>c  ^cu  r.il  pli.i^c-  nl  liiilicr  Ic^-  \t  lii-i.  .ifu  i  \\\v  d.ivj 
of  amiria.  tlnrc  w.i-  lii>~  of  luillcr  fi  ii  .icid  ;  w  iili  -li^lit  i  liiiii  .4  iiiiproM'- 
iiicnt  and  ilic  k  i -t.ilili^liincnl  -ii  iiiiii.nx  -i  i  iciinii.  InilK  r  tor  ncit! 
ri  turned,  w  In  i  ca-  tiiat  fdi  .dk.ili  w.i^  iliiniiii-luil  A  fui  iiilcii-i\c  alkali 
tlicra]i\'.  .111  alk.ilioi-  \\a-  c-talili~licil  llidUi;li  the  aKcular  carlmn  (li(i\i(l 
\\a>  .still  siiiiu'wliat  io\V('rc(l :  ilic  luitfi  r  v.iliic-  were  normal.  October  6, 
a  slitjlit  ^cl  back  dicnrrcd.  with  In---  ni  biiiur  im  .dk.di  It  \\.i-  I'mi.;- 
nosticatcil  at  tliis  time  from  llu  liiiffcr  (litcrniinatioiis  that  llie  alveolar 
carbon   dioxid  tension,   wliiih   iwd  d.iv-   ]ire\idii>lv   li,id   been  nonn.d. 


11.  I.fini<l-tf.(     \     \^.^,lk     I      .1"!    |-..i'.^    (1      /t.ili    I    1.1.1.     \I..!     I'l. 
Ixw.  M)\ 


•  • 


• 


^ 

-    '    ~  'Z  ■ 

■r 

-l^'^i  '.!_  =  * 

->.=  "*"•-  ^'  i 

- 

r  i:  ^  r;  'J  =  ■^  p  ,E  , 

t — 

^  ""  :£  —  "  5  T 

^ 

^—i  —  —  =   t   t-r  — 

—  "■ 

l§!'.riil| 

^ 

-  -  r.  i'-  '-  ^  ~^-i 

-  *  . 

||^-|;^^x 

■- 

^  i£"r  J  5Z—  ■     - 

■  -  ¥  = 

^ 

-iirl.l'^'Z^'i 

=lii 

= 

If.l^i'tl^fM 

=  |ix 

^ 

> 

-            -  - 

*" 

-, 

,_ 

. 

■?  a  i 


-:     ~     ". 


I-      I-  r» 


s    1=    ,    ■• 

I     +       -r     ,     ^ 


r-      «      i» 


';4         -         <l         —         S 


'.?  a  ■=? 

I-     I-     I- 


■■a  ;? 


1?  •.?     ;^ 


..^     i.T     tft 
■•     .--I     I- 


-   - 

:  i!i    lili 

iki 

5           S           1 

9        a        « 

i 

■"^7C      '~*  C  ^  y^ 


-  ■_■       z  -~      z  ^  f  =  '"'  t  :=  "  '■'' 

..a      £ 

■^r           ""            ■•■•       ■"n^-xs-* 

~  —  * 

rr    Ts;     !;"t-i-"'7:-r 

?  t  ="? 

^~    ■^  ~  £    "^  =;;"''' ^"i  =  H^ 

i."*— ^ 

'■        s 

i      —       ?_      ~--ZC="~  ^-S 

• '  ~  —  ^ 

i-~u"^    ■i:"-S>=-i:r 

V  ^  ■=  ^ 

^.r  /.|  i  E  =  =  cf  =  ^,J[;  =;^ "? 

U7    _;    = 

^^^■=I:t:l=.-r"i-'l^=  = 

.  "i     '    H 

—  "..£. 

>• 

ilrll^H^llhll 

^'■^  T  ="1 

'''■'_:     k"   £"        <  '  <     ~ 

';^    '  C 

«  'j   ^ 

I-      I-      I  - 


•rf    -i    '=3 

t^        I-        I-. 


':1  a 


—       —       — 


11 


«  n  C 

11^ 


^1        111 
•  -         ".r  0 

Iv:         |3 


5  «  2  ' 


1(» 

u.mM  1.C  tniHKl  to  l.c-  af,'am  InwcnM.  which.  iiuUr.l.  i.rove.l  to  be  true. 
Finally,    .lunnu    .nnval.^.v.u ,  .    hmh    pll    an.l    Imtl.r    value-    became 

norni.-il,.  ..... 

IIk-  In-s  of  Imller  t.ir  alkali  .,b-erve,l  iirtuu  m^t.iucc-  ..t  tehnle 
t\,,hni,l  aa^e^  S  an.l  "i  i~  m  aec.ml  with  the  tendency  toward  r.n 
a'lU,-,l,,.i.  which  we  h.ave  ob^Tved  in  ^e^er,al  c.-,m  .  of  ihi-  disease. 

-,M;I|-    7      \( I-;    NiNK   Casks:    Tuim\-I-"1k    |)i  ii  rminatim.n- 

Blon'1 

Aci.r  '  AlKMi        ;|^" 

l^^ZZ^^      Av.Ti.urs~    K.ttroii.-      .Awragos     K.-(lreinc-«      Average' 

Kntlri'  grcmp  i'.'  vnfe^.  2i  j,  ,|^-  ^   -(i.l  u.lT 

lietiTuiiuatloDsi... 

ni.riiKT      ftni!.'     <i{      uw 

ilfteriiilnatioos' 

Iinring     fliigl"     of     lOln 
I»-iisatliin     I'i    c»sos:     *  ■  .,  \„ :. 

■  I.'lcrminatliins'.  '"  "' 

TM'.IF    K-SVMMAKN     ..K    .\.  II.      .\1KAM    AM>    TuTAl.    lilFRR    VaUIS    FOR    IHi 
VaRIhIS     C'ASb     C.R'.M-.     I'.XrRh>SHl     A^     l.RHfP     .\VI.R  \CI.S 

llliif"! 
~"     AciiT  Mk:i''  ■'"'■" 

Niirliial    imlivi.liKil!-      

MiM.lliin.M.u*   luw-    Kill,    mirnial    pll.   flmwing    imr  ^  j.  |,.,„ 

liinl  bilrtT   viilnc'» 

<„.■■.    nitl.    iMTiiiul    |ill    .Lowing    itiniinl'tiiM    t.MfT.T  ^  ^^  j^^^^j  „ ._,. 

viiliir* 

■'"■'••'■  .,„MK.n.„...i  "'O  »'»  "■■"' 

4  /.„/,,,.>  ,  lal.K-  i>  am!  7.)  I- n.ni  llir  lahh-  it  i-  .v  i.lent  th.at 
ca»e*  of  aeido>i>  have  1.  -  bulter  fur  both  acl  ,n,.|  ,,lkali  dnnno  il,e 
Mane  nf  uncomi.en«:ae<l  acia..>is  (increased  id!  of  the  blood  I  than 
.lurini;  lb.-  >tai.'e  in  which  the  tension  of  alveolar  carbon  dioxul  is 
,li,nini>iied.  b.it  the  id!  of  the  blood  1^  norm  d  i  M.iye  of  co.npen>ation ). 
lk->l,ite  Ihe  return  to  normal  of  ,,ll  and  bulter  value-,  the  cbmcal  evi- 
dences of  acidosis  may  i.ersist  (Cases  4  and  8). 

1   M-l  KIMlNtM,   <.lS>nil:i<  MInNs 

Ina-much  :.-  tlu  bull  r  value  ..f  blood  i-  fairly  constant  in  health, 
and  deereased  in  .acidosis,  the  question  ubxiously  arises  as  to  wliethtr 
l.ufiVr  can   b,    sn,,,,lif,l       The  possibility  of  accomrlisbiuj-  tins  with 


1^ 


n 

,,!,„.pl,au-  nuMu,v~  ua^  >,,nM,kv.,l  I  lu  ImlUr  ^alnc.  ...  ,.h,p.l.a,r 
Inixtim.s  ,.\a  IIP'  '  Kll  I'm.,  „i  van,.,,-  ~;m,.,ih~  a.ul  Inalro'^cu- 
i„n  oonce.uratiun^.  u.n  .iun-,.,,-.  ,kt.-rnn,K  ,1,  Uk-  rr^ult^  a,,,.arn,g  u! 

l.-,,,>n  Ihi^  ~u,.U   f.nv  MiKix-mi--;  la>  W  an-  ex  id.-nl  :     lu-l.  ll.c  huUvV 

,alu.  ..f  M !   ,^.,vaur,hautha,   nl    .  „   n.-t-vnlar  ,  In 'i'l-U'   ""^ 

tUR-  an.l  ai.pn.xin.atcK  tha.l  nt  ' .-,  niuKvular  nuMiuv^  ;  -com.l.  the 
LulU-r  ^ahu•  i^  '^tvaur  at  nrturalilv  tlian  ni  .m.iv  alkahno  nnNUuv>: 
lliir.l  the  .liah-al.-  c'xlnl.il  l.atV.T  value-  eo,„i.aral.k-  tn  tlf-o  ..btaiiict 
!,v   a.Mi.iii   tlu-   i.uli.atnr   anartlv    tn    tlu-   nri.uinal    nuMiirr-,   In.t    at    a 

1  \L;I,I-  •>.     \UnfM  Vami-  o^r.u,SfiiMi_MiMrKK:-   ,  \  v  Ul'i  i.    -   KH  VO,) 
,  :;.,  Mol«..l,,r  UnJSoWtuUn  1  J^lnlwuhn 

"in.l^^Tlyz.M""      I.inly^ai..  lndU.bV"l         rmllalyz."!        Iil..lN>ai. 


I'll 

7  ■•.'• 

7.1 

111  llll.l 

7  4'i 

7.3.-1 

:.i 

7.5 

-I1.-2  ilCiit 

7.4 

7.25 

715 

7.4." 

■  0.3  iici.i 

7.3 

7. IS 

7.15 

7.1 

-l>,l  iiclct 

-.•.• 

7.1 

7  1 

-11.1  iilkoll 

7  •' 

-  r^ 

7.3 

7.5 

-O-J  alkiill 

7.7-. 

7.11'i 

".:!5 

'•■- 

-03iilkiiM 

7.- 

7.7-'. 

7.» 

T.?» 

'a.4itlkiili 

«  II 

7.S 

"■*' 

iixE-rirTKiM  H    \i..w 


M<  \I.I       K 


KM.INC-    OS     rMH.M.Y/KIl    MIXTfRKS 


I'll 

.  ..lu.ia 

■  (1.2  ml.l 
11.3  ai'iil 

O.l  :llk!lll 

ii.->  niknii 

II  ::  iilkiitl 


7.05 
7.M 

li.'.Ci 
7  »5 
7.U5 
7.1 


7.15 
7.15 

7.75 

7.3 

7.r 

7.35 

(i.O 

7.4 

8.1 

,„„,nniih  n„..a  .,.  ,.1  !.m  !  .  ..".1.  Imall-.  .  Hm  tmii,  .  ..nrmir.itr,!  the  mix- 
ture emi.lu>eil.  Ih,  U--  nuiU.il  i-  the  .h-.  re|u,u  .  helueel.  lite  UU.ha- 
l\ze<l  UliMuia   .mil  ilialv  -,ili' 

\ttetlllit-   tn   mere.a-e   til.     hllH.r    \  ihle  ut    the   hli 
mjeetinil  ot    i.hu-l.h.ale  iniMUle-   lutn  ,nnni 

(Tahle  <).  Ca-e  4i    Inle.l.  hul   .  leim  .n~nale.l  tiu    inllnxMim   M'l- 
1.     The  iihii-hlMie  UiiMui.       >re  lel.iluelv  tu.nlnMe  '- 


h\    uilr.a venous 
,1,  .ill,]  iMiii  ,1  human  case 


\2.  Sw.  aUd.  (iri'.iiual.l.  1  .  .lour,  riianii.unl.  ami  l-.x) 


,1  |-.\ii.r    llurai.     I'M.i,  vii.  .v. 


<  * 


a   I 


s 


if  -      — 


t-  i- 


13     ■■ 


=v     !*     !*     ■= 


2     VJ     S     S        S     ?     S     W     £     =     ^     T?     ?!     ?     ?.     '« 


z 
i 

< 


o 


5  « 


I 


o   u  I 

5  i 


a 
o 


-  i  •    I  :,=: 


.J 


a  3  —    . 

•""<  =  ■ 


p  'J 


■-;    S    S    «i    S    .^    = 


£    S    S    S    S    S 


=  s 


14 

2.  1  111-  iiiii-i'iiiiii  Ml'  -(i.lmiii  iiliii-|ili.it<  I  .\;i  I  i  I 'I  >,  I  iSiii)  ;a'.  nf  i 
'  -  miik\'iil;ir  sdhitiiiii  npfc-nuini,'  _'S  ?  ^iii.  ..f  llu-  -alt  i  iiilci  an  animal 
III  11  ki,'.  dill  mil  pniiloro  an  alUalo-i  or  innra-i-  liu'  Imltcr  values. 
\vliciva>  \\w  inii-clinn  nt  7r*^  ex  <<{  a  'i,-,  nmiiiular  nnxtnn-  ni'  ili-Mi- 
iliiini  |ihii-i'iialc  i  .\a  I  1 1 'i  i,  i  ami  a.iil  ]iiila--iuni  iilm-iilialc  i  Kl  I  l'<  ),) 
at  I'll  ~.n  inlii  a  ilni;  wciyliini.'  (i.<i3  ki;  .  proihi' i-.l  a  miM  aciilu^i-  willi- 
•  iilt  a|i|ii\^ialil(.'  ilianyi'  in  luilli-r  \  ahu-- 

•v  llu  intia\ (.11(111-  iiijutimi  uf  ,itKl  im-.  dl'  a  )ili(i-|ilial(.'  inixliirc 
al  ;ill  7.-1.  i(ii;clli(.T  with  .^(Hl  i-i-,  nl  ,i  4  ]icr  ('.nt.  -(ilutimi  ol  -(uliuiil 
liii-ailidiialr  in  lite  ('a-r  (il'  a  man  (l\ini;  in  urcmii-  inina.  (  an-cil  a  cliansi' 
in  llio  ]ill  dl'  llu'  1i1(m;(1  frmn  7  .\^  in  7.33.  and  in('ri'a-i.d  lli(.'  liulUf  idr 
alUali  liut  mil  idr  a(id.  Ilicrc  \\a>  no  ('hanm'  in  llu.'  iliniial  cdmlitidn 
■  if  the  1  alii'iu.  wild  died  l\\(i  himrs  lali-r. 

Hull  I  r  I  i:liiis  ill  l\.vpcrinuiitiil  .Lnh'sis  and  Alk^ilosis. — I  Tahlcs 
jil.ind  111  It  i---i.in  irum  l\|i(  rinunl  1  tliat  in  tin  aoidii-is  jmiduci'd 
liv  tlR'  iiilra\cndii-  inji^'liim  nl'  an  indri.;anii.'  acid  i  liyilnu'lilnrir  a<.-i(l  ) 
iIk'  hiifUT  \aliU'-  ma\  ii'inain  iiraclicallv  imnnal,  alllidiiiih  thcfi'  i-  a 
di'iidi'd  Iduci'iny  111'  llu-  ,d\(iil,ir  .-avlnin  didxid  and  .i  inaikcd  iiuna-i. 
Ill  thr  jil  I  dl'llu-  liliidd.  1  hi-  i^  ill  accdril  willi  wlial  i-  -niiK-liinc--  I'dimd 
Ml  llu.'  aciild-i-  111  ihrniiu-  iu']ihrili-  with  uremia  and  in  llial  nl  (lialii.-ti-- 
.  l.iIiU-  11.  ia-c-  1  Id  ''.  imlu--i\i' I.  .\l'u-r  iiiji'i-lidii  (it  alk:ili  tu  dvev- 
I'diiic  llu'  aiidd-i-,  lluii-  i-  a  lran>ii-iil  diininutidii  in  tlu'  hufft-r  tor 
alUali.  l'(itlii\vi-d  li\   a  )iri  mpl  r(-turii  Id  mirinal  \aliK--  a--  llu-  jdl  nt'  tlu- 

Mddli     1-    IdUelCil. 

In  i-\|i(.rinK-iilal  alkald-i-  ihc  liin'lcr  I'nr  aiid  i-  lir-t  dimini-lu-d. 
llu-  ahcdiar  r.irlidii  dinxi.l  ri-e-  tn  iiiin>i;all>  lii.i;li  liyiiro  -fo."  mm, 
in  llii--  animal.  Al'li-r  iniotidii  df  -utticictil  hxdrdililnrii'  aciil  Id  dvii- 
ciinu.-  the  .dkald-i-  and  iirndiui  .a  iniM  aii(ldS!<  with  idWiTi'd  alvcdlar 
..irlidii  didXid  Uii-idii.  tin.'  liiiliir   t-ir  Imih  ai'id  and  all-ali  i-  ln-M-rcd 

In  llu-  in-laiuo  nl  nu-ri'iii  ic  chldrid  |)di>diiiii^  i(  a-o  4.  lahk-  4i.  in 
which  llu-  ]iatimt  n.'cci\i.(!  lari;c  ild-c-  of  -ddiniii  liii-arlmiiatc  Imlli  li\ 
iniiuth  and  iiitra\i'ndn-l\ .  a  -iniilar  idiidilidii  nl  alkaln-i--  \\  a-  ]irddui  id. 
tllciUjLlh  lure  tile  lilltTer  \.iliu-  riiiianud  luuiiial  .it  llii-  ~:.iL;e  nl  llu-  di-- 
la-e.  and  the  ahenlar  e.iiliiin  duiMil  Ini-Uin  w.i-  -lill  lnw       ,i,i.(l  mm    nl 


I      \  -imiiK-  niitlidd  i-  di-irilud   iHi    'IrU  rminiiii,'  (|iianlitati\  el\   the 

liiiiur  \,iUu   III  llu    111 1,     li  e.in-i-i-  m  .iddini;  iiuTeasini^  amdUiil-  ni 

lil'lielli-ndi'm.d  li\  di  i  h  lilnrii-  aeid  and  li  ft  ielh  iiiinn.d  -ndniin  li\drd\iii 
-dlutiiiii  Id  ri|!i,l  i|ii,i;nitie-  III'  liliiiiil  .Mill  iili-i-r\  iiil;  the  rr-iiltin;' 
■.hansel-  m  Indnimn  um  >  i  nu  i  nlr.iluiii  li\  iiuaii-  nt  the  diaU-i~ 
iiidii'aliir  nuthdd 


15 


2.  I  hr  ivMil'-  ,ii-.-  cN^iv-  ,M  in  u-nii-  "i  'iiln.'  ■  riiliiiulrr-  ui  lil'lirlli 
ii.Tiiial  .1.  I'l  "T  :ills;ili  I'cr  2  '-X-  "i  1i1(iim1. 

.;.  Ihr  ImH.r  \aUu'>  ni  hlou.l  fur  acul  .iiid  .ilkali  yu-1.1  valiuil.lc 
ininniulK.n  n-ni  a  rliniral  Maiidpoint.  'I'lio  rc-cvM-  and  lulal  l.iiU.  r- 
mav  al-o  l.r  calmlalr.l   lr..iii  iIk-  rt-iili-  of  tlic  .Iflcrniinalions. 

4.  riu  iiiininial  \aUu~  for  norinal  Monil  liavo  liocii  (K-tcriiiiiud ; 
,.m-.i.l>-ral.l\  lar-cr  \aUlt>  may  be  ciu-oumi-rol,  l"or  a  -roiti)  of  mi- 
^x'llanrnii.  ,'a.i-,  with  iioniial  i.ll,  tlu'  avcrayi-  Imtlcr  vahu-  wi-ru  -.im- 
wliai  lowiT.  ilioush  williiii  iioriiial  liniil-^. 

3.  Ill  .cnaiii  ca>i-  witli  normal  ]A\  of  tlic  l)luod,  but  >b()\viiis  a 
liiHkiu-v  toward  llu-  dovclopmnit  ..f  an  an.losis  las  evidcii.-c<l.  for 
.xami.K-.  bv  lounvd  alv.'olar  .arbmi  diuNid  toit-ioin.  tlic  Iniffcr  values 
UU-.  .Iniiii'ii-lud,  ill.-  lo"  .>f  buflVr  for  alkali  wa,  far  more  strikin- 
an.l  inqui'iil  than  for  arid,  and  ua^  ofti'ii  a-.R-iated  with  lowcroi 
alveolar  rarboii  ,li,)xid  trii>ioii.  \~  a  iv-ult  ol  therapy,  o-i.eeiallv  the 
u-e  of  alkali,  llie  bulVer  \alue>  in  Miine  iiiManees  returned  to  normal. 
(..  In  .1  >erie-  of  ..i^e^  ..f  aeido-i~  the  .average  buffer  value-  were 
fwniid  lo  be  iiiarkedlx  dinmii-hed,  partieularly  durin-  the  <tat;e  in  whieli 
tbe  idl  Ml  ibe  bl.'od  wa-  .ibiiorni.dly  bi.i;li.  Xonnal  bulVer  values  inay 
be  uieounlered.  b,n.,>.e\er.  in  the  pre-enee  of  a  true  aeido-is.  Coincident 
with  eliiii.-.d  imiivovenieiit  follnuin-:  treatment,  partienlarly  inten-ive 
alkali  llierai'V.  both  jdj  ;iiid  btUler  x.due-  a|.i.r..Nini.ite.l  or  beeame  nor- 
mal in  -f\er:il  ease-. 

7.  ,t  wa-  nut  lM,-ible  to  -ui^plv  bnliVr  lo  tlie  bkn.d  bv  the  injeeti,.  i 
iif  iilid-idiate  mixtures. 

S.  l',y  till'  intraven.ui-  injeetioii  ol  tbir.l  ii.  .riiial  bvdroehlone  aeid 
and  4  i.'er  eeiil.  -.Mdiuni  biearlnniale  -olntiun  into  d-u-.  e,,nditions  ot 
aeido-i-  and  alkalo-,-  x\efe  produeed  vvbieb  ueie  nie,  ,ii-lantlv  aeeom- 
jiailied  bv  eh;in,m-  in  tbe  bnlVer  \alne-  of  the  blood, 

9  riie  deleiniinatioii  of  tbe  biilfer  \:dne  of  the  blood.  e-|)eei;illy  in 
cases  111  uhi.l,  ,ni  .aei.lo.,-  i-  Mi-peeied  m-  |,ie>em.  vields  information 
of  some  <lia-noMie  and  vVMon.„;,e  M-nitu-ance  and  peiinit-  of  a  ni.aa 
.■omplete  -tnd\  oi  the  (..et-r-  e.aieeiaied  in  the  mainten.iner  ,,i  th.- 
aeid-ba-e  e(|nibbrinin  of  tbe  bo'1_\ 


